经口CO2激光手术治疗前连合受累的声门型喉癌疗效观  

Treatment of glottic cancer involving the anterior commissure by transoral CO2 laser surgery

作　　者：黎景佳[1] 张剑利[1] 何发尧[1] 汤苏成[1] 朱肇峰[1] 陈伟雄[1] 

机构地区：[1]佛山市第一人民医院耳鼻咽喉头颈外科,广东省528000

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第5期337-342,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广东省科技计划项目（2014A020212075）;广东省自然科学基金项目（2016A030313245）

摘　　要：目的 探讨经口CO2激光手术切除前连合受累的声门型喉癌的可行性与临床疗效。方法 回顾性分析2009年3月至2013年12月接受经口CO2激光手术治疗的32例前连合受累的声门型喉癌患者临床资料，其中T1bN0M0 27例，T2N0M0 5例。结果 32例患者均顺利实施经口CO2激光手术，围手术期并发症发生率较高的为软腭或咽侧壁黏膜撕裂（13/32，40.63%）、门齿松动（3/32，9.38%）和颈部皮下气肿（2/32，6.25%）。随访期内，32例患者均出现创面肉芽组织增生，术后1-2个月为肉芽组织增生的高峰期，3个月后肉芽组织逐渐缩小，4-6个月时肉芽组织可完全消失，仅残留局部瘢痕或前连合粘连。3例出现局部复发，其中2例再次接受激光手术，1例行喉全切除术，3例随访5年均无瘤生存。2例出现颈部区域复发而无原发灶复发，其中1例行颈淋巴清扫术，随访5年无瘤生存，另1例术后40个月出现右锁骨上淋巴结、纵隔淋巴结转移及肺转移而死亡。Kaplan－Meier法计算本组患者5年总生存率90.6%，其中T1bN0M0病变者5年生存率92.6%，T2N0M0病变者5年生存率80.0%，二者差异无统计学意义（Log Rank检验，χ^2=0.788，P＝0.375）；总5年局部区域控制率84.4%，其中T1bN0M0病变者5年局部区域控制率92.6%，T2N0M0病变者5年局部区域控制率40.0%，二者差异有统计学意义（Log Rank检验，χ^2=9.504，P＝0.002）。结论 对于前连合受累的声门型喉癌，在严格掌握手术适应证，详细进行术前评估，恰当进行手术操作以及严格遵循肿瘤外科原则的前提下，经口CO2激光手术可达到满意疗效。Objective To study the clinical outcome of transoral CO2 laser surgery for glottic cancer involving the anterior commissure. Methods Thirty-two cases of glottic cancer involving the anterior commissure treated by transoral CO2 laser surgery between March 2009 and December 2013 were retrospectively reviewed. Among these cases, 27 were T1bMOM0, 5 were T2NOM0. All cases were followed- up for more than 3 years. Results All the 32 cases were successfully treated. Perioperative complications included injuries in the soft palate mucosa （13/32, 40. 63% ）, loose incisors （3/32, 9.38% ） and subcutaneous emphysema in the neck（2/32,6. 25% ）. During the follow-up period, granulation was found in all cases. Three cases had local recurrence. Two patients treated by a secondary transoral CO2 laser surgery and the other case had total laryngectomy, all three cases were followed up for 5 years without recurrence. Two cases had regional recurrence but no primary site recurrence. One patient was treated by neck dissection, and followed up for 5 years without recurrence. The other patient died of supraclavicular and mediastinal lymph node metastasis and lung metastasis 40 months after operation. The overall 5-year survival rate was 90. 6%. There was no significant difference in survival rate between TlbNOM0（92. 6% ） and T2NOM0（80. 0% ） （Log Rank χ^2 = 0. 788 ,P = 0. 375 ）. The overall 5-year local regional control rate was 84. 4%. In TlbNOM0 lesions, the 5-year local regional control rate was 92. 6%, which was significantly higher than that in T2NOM0 lesions （40. 0% ） （ Log Rank χ^2 = 9. 504, P = 0. 002）. Conclusion With appropriate surgical indication, detailed preoperative evaluation, good surgical skill, transoral CO2 laser surgery may achieve satisfactory outcome in the treatment of glottic cancer involving the anterior commissure.

关 键 词：喉肿瘤 声门 癌 鳞状细胞 激光 气体 预后 

分 类 号：R739.65[医药卫生—肿瘤]